Truck Accident Demand Letter Template
Date: [Date]
Sent Via: ☐ Email ☐ Certified Mail ☐ Online Portal ☐ Other: [Method]
Claim Number: [Claim # (if known)]
Policy Number: [Policy # (if known)]
From (Claimant): [Your Full Name]
Address: [Your Address]
Phone/Email: [Phone] / [Email]
To (Insurance Company / Claims Adjuster):
[Insurance Company Name]
Attn: [Adjuster Name / Claims Department]
[Address]
[Email/Phone]
Additional Recipient (Optional):
[Trucking Company Name]
Attn: [Safety/Claims Contact]
Re: Demand for Settlement — Truck Accident on [Accident Date] at [Location]
Dear [Adjuster Name or “Claims Department”],
1. Liability Basis (Why the Truck/Company Is Responsible)
1.1 Responsible Parties Identified: [Truck Driver Name] and [Trucking Company Name] and [Other Entity (if applicable)].
1.2 Liability Position: [Unsafe lane change/following too closely/failure to yield/speeding/other].
1.3 Supporting Evidence Referenced: [Police report ID] and [Photos/Video IDs] and [Witness list] and [Other].
2.1 Date/Time: [Date/Time].
2.2 Location: [Street/City/State].
2.3 Before: [Where I was traveling and lane position and speed].
2.4 Trigger: [Action by commercial vehicle].
2.5 Contact/Mechanism: [Point of impact and direction and collision sequence].
2.6 After: [Vehicle positions and property damage and roadway events].
2.7 Immediate Response: [911/ambulance/tow/medical evaluation].
2.8 Vehicles Involved: My vehicle: [Year/Make/Model]; Commercial vehicle: [Year/Make/Model/Tractor-trailer] unit/plate: [__].
3. Injuries and Medical Treatment
3.1 Injuries Reported: [Injury list in plain language].
3.2 Treatment Providers and Dates: [Provider 1 — Dates] and [Provider 2 — Dates] and [Other].
3.3 Current Status: ☐ Fully recovered ☐ Improving ☐ Ongoing symptoms: [__].
3.4 Future Care (if known): [Follow-ups/therapy/imaging/specialist referrals].
4. Damages and Losses
4.1 Medical Expenses: $[Amount] (to date).
4.2 Lost Wages / Time Off Work: $[Amount] (dates missed: [__]).
4.3 Property Damage (Vehicle): $[Amount] (estimate/invoice reference: [__]).
4.4 Out-of-Pocket Costs: $[Amount] (receipt reference: [__]).
4.5 Other Losses: [Rental car/towing/storage/other] — $[Amount].
4.6 Total Documented Economic Losses (Estimate): $[Total].
5. Settlement Demand
5.1 Demand Amount: $[Demand Amount].
5.2 Demand Basis: [Economic losses] and [injury impact and recovery disruption].
5.3 Settlement Scope: [All claims arising from the collision] and [property damage and bodily injury] and [other].
6. Deadline, Payment, Release, and Enclosures
6.1 Written Response Deadline: [Deadline Date (allow 10–20 business days)].
6.2 Payment Payable To: [Name(s)] and mailed to: [Address] or other instructions: [__].
6.3 Release for Review: [Release language requested before payment].
6.4 Attachments: ☐ Police report ☐ Photos/videos ☐ Witness contact list ☐ Medical bills/records summary ☐ Wage loss verification ☐ Repair estimates/invoices ☐ Receipts ☐ Other: [List].
6.5 Signature Block: [See Section 9].
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Claim/Insurance Intake
7.1 Insurer/TPA: [Name] and Adjuster: [Name] and Adjuster Email/Phone: [__].
7.2 Claim Address/Portal: [Mailing address or portal link].
7.3 Policy Holder (if known): [Name] and Policy Type: [Auto/Commercial/Other].
8. Timeline Table (Time - Event - Person - Evidence)
Time/Date | Event | Person(s) Involved | Evidence ID/Attachment |
[Date/Time] | [Collision] | [Driver/Claimant] | [Photo/Report ID] |
[Date/Time] | [Medical visit] | [Provider] | [Bill/Record ID] |
[Date/Time] | [Vehicle inspection/estimate] | [Shop/Adjuster] | [Estimate ID] |
Time/Date | Event | Person(s) Involved | Evidence ID/Attachment |
[Date/Time] | [Collision] | [Driver/Claimant] | [Photo/Report ID] |
[Date/Time] | [Medical visit] | [Provider] | [Bill/Record ID] |
[Date/Time] | [Vehicle inspection/estimate] | [Shop/Adjuster] | [Estimate ID] |
Time/Date
Event
Person(s) Involved
Evidence ID/Attachment
[Date/Time]
[Collision]
[Driver/Claimant]
[Photo/Report ID]
[Medical visit]
[Provider]
[Bill/Record ID]
[Vehicle inspection/estimate]
[Shop/Adjuster]
[Estimate ID]
9. Evidence Preservation Request
9.1 Preservation Requested For: [Video] and [inspection/maintenance records] and [communications] and [trip-related documents] and [other].
9.2 Collision Identifiers: [Accident Date] and [Location] and [Driver] and [Unit/Plate].
9.3 Point of Contact for Preservation Confirmation: [Name/Email/Phone].
Sincerely,
[Your Full Name]
Signature: ___________________________
Printed Name: [Your Full Name]
Authorized Representative (Optional): ___________________________
Printed Name/Title: [Name/Title]
Time/Date | Event | Person(s) Involved | Evidence ID/Attachment |
[Date/Time] | [Collision] | [Driver/Claimant] | [Photo/Report ID] |
[Date/Time] | [Medical visit] | [Provider] | [Bill/Record ID] |
[Date/Time] | [Vehicle inspection/estimate] | [Shop/Adjuster] | [Estimate ID] |
